U.S. patent number 5,781,442 [Application Number 08/440,625] was granted by the patent office on 1998-07-14 for system and method for collecting data and managing patient care.
This patent grant is currently assigned to Alaris Medical Systems, Inc.. Invention is credited to Craig Chamberlain, Joseph J. Engleson.
United States Patent |
5,781,442 |
Engleson , et al. |
July 14, 1998 |
**Please see images for:
( Certificate of Correction ) ( Reexamination Certificate
) ** |
System and method for collecting data and managing patient care
Abstract
A care management system in which the management of the
administration of care for patients is automated. Hospital
information systems are monitored and the information from those
systems is used in verifying the administrations of care to
patients. The care management system monitors ongoing
administrations for progress and automatically updates records and
provides alarms when necessary. The care management system is
modular in nature but is fully integrated among its modules.
Particular lists of data, such as the termination times of all
ongoing infusions, provide hospital staff current information for
increased accuracy and efficiency in planning. Features include the
automatic provision of infusion parameters to pumps for accurate
and efficient configuration of the pump, and providing an alarm
when an unscheduled suspension of an infusion exceeds a
predetermined length of time.
Inventors: |
Engleson; Joseph J. (Carlsbad,
CA), Chamberlain; Craig (Ann Arbor, MI) |
Assignee: |
Alaris Medical Systems, Inc.
(San Diego, CA)
|
Family
ID: |
23749510 |
Appl.
No.: |
08/440,625 |
Filed: |
May 15, 1995 |
Current U.S.
Class: |
700/214 |
Current CPC
Class: |
G16H
40/67 (20180101); G16H 20/10 (20180101); G16H
40/20 (20180101); A61M 5/142 (20130101); A61M
2205/52 (20130101); A61J 2205/10 (20130101); A61M
2005/14208 (20130101); A61M 2205/502 (20130101); A61M
2205/18 (20130101); A61M 5/172 (20130101); A61J
2205/60 (20130101); A61J 2205/30 (20130101); A61J
2205/20 (20130101) |
Current International
Class: |
G06F
19/00 (20060101); G05B 021/02 () |
Field of
Search: |
;235/462
;364/479,413.02,478,413.01,478.02 ;604/31 ;340/712 ;379/93 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Elmore; Reba I.
Assistant Examiner: Lewis; Monica
Attorney, Agent or Firm: Fulwider Patton Lee & Utecht,
LLP
Claims
We claim:
1. A system for programming a clinical device to deliver medication
to a patient comprising:
a first computer having a memory for storing identification data,
patient data, clinical device data, and clinical device operating
parameters and being operably connected to the clinical device;
a second computer for verifying, monitoring and recording medical
treatment provided to the patient, the second computer having a
memory in which is stored identification data, clinical device data
and patient treatment data, the patient treatment data including
medication identification data and clinical device operating
parameters associated with the medication identification data for
programming the clinical device to deliver the medication to the
patient;
first input means operatively connected to the first computer for
input of identification data to the first computer;
second input means operatively connected to the second computer for
input of identification data, patient data, clinical device data
and patient treatment data to the second computer;
communication means for operatively connecting the first computer
to the second computer, wherein identification data input into the
first computer is communicated to the second computer by the
communication means,
wherein the second computer compares the communicated
identification data to the identification data stored in the memory
of the second computer; and
wherein the second computer downloads the clinical device operating
parameters associated with the patient treatment data to the first
computer to program and operate the clinical device in accordance
with the downloaded operating parameters if the comparison of the
identification data by the second computer satisfies a
predetermined condition.
2. The system of claim 1 wherein the first input means comprises a
barcode reader.
3. The system of claim 1 wherein the clinical device data stored
within the memory of the first computer comprises clinical device
location data, and the first input means is operable to input
clinical device location data to the first computer for storing in
the memory of the first computer.
4. The system of claim 3 wherein the clinical device data stored
within the memory of the second computer memory further comprises
clinical device location data, and the communication means is also
for communicating the clinical device location data from the first
computer to the second computer for storing the clinical device
location data in the memory of the second computer.
5. The system of claim 1 wherein the clinical device data stored in
the memory of the first computer further comprises clinical device
usage data.
6. The system of claim 5 wherein the clinical device data stored in
the memory of the second computer further comprises clinical device
usage data and the communication means is also for communicating
clinical device usage data from the first computer to the second
computer for storing the clinical device usage data in the memory
of the second computer.
7. The system of claim 1 wherein the clinical device data stored in
the memory of the first computer further comprises clinical device
maintenance data.
8. The system of claim 7 wherein the clinical device data stored in
the memory of the second computer further comprises clinical device
maintenance data and the communication means is also for
communicating clinical device maintenance data from the first
computer to the second computer for storing the clinical device
maintenance data in the memory of the second computer.
9. The system of claim 1 wherein the patient data stored in the
memory of the second computer comprises medical administration
records, each medical administration record including patient
identification data and medical treatment data.
10. The system of claim 9 wherein the medical treatment data
includes clinical device operating parameters.
11. The system of claim 9 wherein the communication means is also
for communicating medical treatment data input into the first
computer by the first input means to the second computer for
storing the medical treatment data in the medical administration
record corresponding to the patient being treated.
12. The system of claim 1 wherein the communication means
comprises:
a first transmitter/receiver operatively connected to the first
computer for transmitting and receiving identification data,
patient data and clinical device data to and from the second
computer; and
a second transmitter/receiver operatively connected to the second
computer for receiving identification data, patient data and
clinical device data from the first computer, and for transmitting
clinical device data to the first computer.
13. The system of claim 12, wherein the clinical device includes a
third transmitter/receiver for transmitting and receiving clinical
device data to and from the first computer.
14. The system of claim 13, wherein the clinical device data
comprises clinical device location data.
15. The system of claim 1, further comprising a first radio
frequency transmitter/receiver operatively connected to the first
computer; and
a second radio frequency transmitter/receiver operative connected
to the clinical device for communicating clinical device data
between the first computer and the clinical device.
16. A method of controlling the delivery of a medical treatment
from a clinical device, the method comprising the steps of:
storing medical treatment data comprising patient identification
data, medication identification data and clinical device operating
parameters associated with the patient identification data and the
medication identification data in a memory of a first
processor:
inputting medication identification data associated with medication
to be administered to a patient into a second processor;
inputting patient identification data into the second
processor;
communicating the medication identification data and the patient
identification data from the second processor to the first
processor;
comparing the communicated patient identification data and
medication identification data to patient and medication
identification data stored in the first processor;
communicating the clinical device operating parameters associated
with the patient identification data and medication identification
data stored in the first processor to the clinical device operably
connected to the second processor to program the clinical device to
operate in accordance with the clinical device operating parameters
if the comparison of the patient identification data and medication
identification data by the first processor satisfies a
predetermined condition.
17. The method of claim 16 further comprising the step of recording
the patient identification data, the medication identification data
and the associated clinical device operating parameters in a
medical administration record.
18. The method of claim 16 further comprising the steps of:
inputting caregiver identification data into the second
processor;
communicating the caregiver identification data to the first
processor; and
storing the caregiver identification data in the memory of the
first processor.
19. The method of claim 16 further comprising the step of
communicating the location of the clinical device to the first
processor.
20. The method of claim 19 wherein the step of communicating
includes the step of inputting the location of the clinical device
into the second processor.
21. The method of claim 16 wherein the step of communicating the
medication and patient identification data from the second
processor to the first processor further comprises the steps
of:
transmitting data from the second processor using a first
transmitter/receiver operably connected to the second processor;
and
receiving data from the second processor using a second
transmitter/receiver operably connected to the first processor.
22. A system for programming a clinical device to deliver
medication to a patient comprising:
a terminal operatively connected to the clinical device;
a processor having a memory in which is stored identification data,
clinical device data and patient treatment data, the patient
treatment data including medication identification data and
clinical device operation parameters associated with the medication
identification data for programming the clinical device to deliver
the medication to the patient;
first input means operatively connected to the terminal for input
of identification data to the terminal;
second input means operatively connected to the processor for input
of identification data, patient data, clinical device data and
patient treatment data, wherein the processor stores the
identification data, patient data, clinical device data and patient
treatment data in the memory;
communication means for operatively connecting the terminal to the
processor, wherein identification data input into the first input
means is communicated to the processor by the communication
means;
wherein the processor compares the communicated identification data
to the stored identification data; and
wherein the processor downloads the clinical device operating
parameters associated with the patient treatment data to the
terminal to program and operate the clinical device in accordance
with the downloaded operating parameters in response to an
acceptable comparison of the identification data by the
processor.
23. The system of claim 22, wherein the first input means comprises
a barcode reader.
24. The system of claim 22 wherein the memory also stores clinical
device location data.
25. The system of claim 24 wherein the terminal is operable to
receive clinical device location data from the clinical device and
the communication means is also for communicating clinical device
location data, wherein the terminal communicates the clinical
device location data through the communication means to the
processor and the processor stores the clinical device location
data in the memory.
26. The system of claim 22 wherein the memory also stores clinical
device usage data.
27. The system of claim 26 wherein the terminal is operative to
receive clinical device usage data from the clinical device and the
communication means is also for communicating clinical device usage
data, wherein the terminal communicates the clinical device usage
data through the communication means to the processor and the
processor stores the communicated clinical device storage data in
the memory.
28. The system of claim 22 wherein the memory also stores clinical
device maintenance data.
29. The system of claim 28 wherein the first terminal is operative
to receive clinical device maintenance data from the clinical
device and the communication means is also for communicating the
clinical device maintenance data, wherein the terminal communicates
the clinical device maintenance data to the processor and the
processor stores the communicated clinical device maintenance data
in the memory.
30. The system of claim 22 wherein the identification data and the
clinical device operating parameters stored in the memory comprise
medical administration records.
Description
BACKGROUND OF THE INVENTION
The invention relates generally to systems for managing patient
care in a health care facility, and more particularly, to systems
for collecting data and controlling the delivery of patient
care.
Medical institutions are faced with a competitive environment in
which they must constantly maintain or improve profitability and
yet simultaneously improve patient care. Several factors contribute
to the ever increasing costs of health care, whether it is
delivered to the patient in a hospital or out-patient clinic
setting. Health care deliverers face increased complexity in the
types of treatment and services available, but also must provide
these complex treatments and services efficiently, placing a
premium on the institution's ability to provide complex treatment
while maintaining complete and detailed medical records for each
patient.
It is also advantageous to have a care management system that
combines all of the various services and units of a health care
institution into an interrelated automated system to provide
"just-in-time" delivery of therapeutic and other drugs to the
patient. Such a system would prevent administering an inappropriate
medication to a patient by checking the medication against a
database of known allergic reactions and/or side-effects of the
drug against the patent's medical history. The interrelated system
should also provide doctors, nurses and other care-givers with
updated patient information at the bedside, notify the
institution's pharmacy when an additional drug is required, or when
a scheduled treatment is running behind schedule, and automatically
update the institution's accounting database each time a medication
or other care is given.
Inaccurate recording of the administration of drugs and usage of
supplies involved in a patient's treatment results in decreasing
revenues to the institution by failing to fully capture billing
opportunities of these actual costs. Inadequate management also
results in a failure to provide an accurate report of all costs
involved in treating a particular illness.
In many hospitals and clinical laboratories, a bracelet device
having a patient's name printed thereon is permanently affixed to a
patient upon admittance to the institution in order to identify the
patient during his or her entire stay. Despite this safeguard,
opportunities arise for patient identification error. For example,
when a blood sample is taken from a patient, the blood sample must
be identified by manually transcribing the patient's name and other
information from the patient's identification bracelet. In
transferring the patient's name, a nurse or technician may miscopy
the name or may rely on memory or a different data source, rather
than actually reading the patient's bracelet.
Moreover, manually transferring other information, such as the
parameters for configuring an infusion pump to dispense medication
may result in errors that reduce the accuracy and/or effectiveness
of drug administration and patient care. This may result in an
increased duration of treatment with an attendant increase in
costs.
Hospitals and other institutions must continuously strive to
provide quality patient care. Medical errors, such as where the
wrong patient receives the wrong drug at the wrong time, in the
wrong dosage or even where the wrong surgery is performed, are a
significant problem for all health care facilities. Many
prescription drugs and injections are identified merely by slips of
paper on which the patient's name and identification number have
been handwritten by a nurse or technician who is to administer the
treatment. For a variety of reasons, such as the transfer of
patients to different beds and errors in marking the slips of
paper, the possibility arises that a patient may be given an
incorrect treatment. This results in increased expense for the
patient and hospital that could be prevented using an automated
system to verify that the patient is receiving the correct
care.
Various solutions to these problems have been proposed, such as
systems that use bar codes to identify patients and medications, or
systems allowing the bedside entry of patient data. While these
systems have advanced the art significantly, even more
comprehensive systems could prove to be of greater value.
What has been needed, and heretofore unavailable, is an integrated,
modular system for tracking and controlling patient care and for
integrating the patient care information with other institutional
databases to achieve a reliable, efficient, cost-effective delivery
of health care to patients. The invention fulfills these needs and
others.
SUMMARY OF THE INVENTION
Briefly and in general terms, the present invention provides a new
and improved patient management system capable of monitoring,
controlling and tracking the administration of care in a health
care institution.
Generally, the patient management system comprises a number of CPUs
having a variety of input and output devices for receiving patient
data and for generating or displaying reports. A system of software
programs operates on the CPUs to record, process, and produce
reports from a database whose data is representative of the care a
patient receives in the institution. The CPUs are connected
together, along with at least one dedicated file server, to form a
network. Patient data is input by users of the personal computers,
and is stored in a data storage device connected to the file
server.
More specifically, in a more detailed aspect by way of example and
not necessarily of limitation, the patient management system
includes a pharmacy computer, a nursing station CPU including a
video display and printer and bedside CPUs connected to various
clinical devices such as infusion pumps for providing medication to
a patient and a barcode reader for reading barcode labels either
affixed to the patient's identification bracelet or a label on a
medication container. In operation, the patient management system
verifies that the right medication is being dispensed to the right
patient in the right dosage via the right delivery route at the
right time by maintaining a database of information relating to the
patient, the patient's condition, and the course of treatment
prescribed to treat the patient's illness.
The patient wears an identification device that includes a barcode
that can be read by a barcode reader connected to the bedside CPU.
Medication to be administered to the patient in the course of the
patient's treatment is identified with a label that is printed by a
barcode printer in the pharmacy or by the manufacturer's supplied
barcodes on unit dose packaging. When the medication is
administered to the patient by a care-giver, the care-giver uses
the barcode reader connected to the bedside CPU to read the barcode
on the patient's identification device and the barcode on the label
identifying the medication to be dispensed. The patient management
system compares the patient's identity with the medication and
verifies that it is the correct medication for the patient.
Additionally, the care-giver may also have an identification device
that bears a barcode with the care-giver's name and other
information. Using the barcode reader, the caregiver's identity can
thus be stored in the database and linked to the treatment given to
the patient to ensure complete and accurate tracking of all
treatment given to the patient.
In a further aspect, the patient management system also includes
the capability of recording the present location of each clinical
device in the institution, and maintains a history of the device
usage in a device usage and event database. This database may also
include a history of a device's maintenance and calibration.
In another aspect, the patient management system includes the
ability to track usage of consumable supplies within the various
units of the health care institution. This assists in managing the
inventory of consumable supplies to ensure that supplies are always
available. A further advantage is that it enables the institution's
administration to project supply usage and thus purchase supplies
in quantities that ensure cost discounts without incurring
excessive inventory carrying costs.
In yet another aspect, the patient management system employs RF
(radio frequency) transmitters and receivers to connect the various
hardware elements of the system together into a local area network.
This aspect is advantageous in that it provides increased
flexibility in positioning of the hardware elements of the network
while eliminating the need for costly network wiring throughout the
institution.
These and other advantages of the invention will become apparent
from the following more detailed description when taken in
conjunction with the accompanying drawings of illustrative
embodiments.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a graphic representation of a care management system
incorporating principles of the present invention and illustrating
details of the hardware elements and local area network;
FIG. 2 is a functional block diagram of the care system of FIG. 1
additionally showing an interface with other institutional
information management systems;
FIG. 3 is a functional block diagram of the software modules that
comprise the care system of FIGS. 1 and 2;
FIG. 4 is a graphic representation of a patient identification
bracelet including a barcode that can be read by a barcode
reader;
FIG. 5 is a drawing of a barcode label affixed to a medication
container that can be read by a barcode reader;
FIG. 5A is a drawing of a barcode label affixed to a caregiver
identity badge.
FIG. 6 is a drawing showing a sheet of barcode labels that can be
affixed to various containers or devices;
FIG. 7 is a graphical representation of a display on an infusion
pump showing the name of a drug being infused along with other
information relating to the infusion;
FIG. 8 presents a computer screen listing of the infusions in
progress showing the drug being administered, the time remaining,
and the patient's name;
FIG. 9 shows a patient IMAR (integrated medication administration
record) showing scheduled medications and windows around the
scheduled times;
FIG. 10 shows a computer screen task list for a partial floor of a
hospital in which times for administration in a certain time period
are set out along with the patient name and drug to be
administered;
FIG. 11 shows a computer screen used for rescheduling the
administration of an order;
FIG. 12 presents a computer screen containing an overview of a
partial floor of a hospital in which various patients' rooms are
shown with the names of the patient;
FIG. 13 is a graphical representation of another embodiment of the
care management system showing the clinical devices connected to
the local area network through a bedside data concentrator;
FIG. 14 is a graphical representation of still another embodiment
of the care management system showing the clinical devices
transmitting and receiving information from the local area network
through RF transmitting/receiving equipment; and
FIG. 15 is a graphical representation of another embodiment of the
care management system of FIG. 9 where all of the hardware elements
of the local area network communicate with each other using RF
transmitting/receiving equipment.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring now to the drawings, and more particularly to FIG. 1,
there is shown generally an integrated hospital-wide information
and care management system 30 including one embodiment of the
point-of-care management system 30 of the present invention. The
care management system embodiment shown in FIG. 1 is depicted as
being configured as a local area network with a file server 45 to
which are connected a pharmacy computer 60, a nursing station 70,
and bedside CPUs 80. The file server 45 stores programs and data
input and collected by the various computers in the local area
network. Various application modules of the patient management
system may be resident in each of the computers in the network and
will be discussed in more detail below. Ethernet cabling of a local
area network 50 is used to connect various CPUs to the file server.
The file server 45 also has both local and network hard disk
storage for storing programs as well as data gathered on the
network.
Referring now to both FIGS. 1 and 2, a functional block diagram of
the patient care management system 30 of FIG. 1 is shown in FIG. 2
interfaced with and connected to other hospital information
management systems to form an integrated information and care
management system. This information and care management system is
integrated with a combination of individual hospital systems, such
as the pharmacy information system 20, and the hospital
administration system 40 which are interconnected via a network 5
and appropriate interfaces 10. Each of the various systems 20, 30
and 40 generally comprise a combination of hardware such as digital
computers which may include one or more central processing units,
high speed instruction and data storage, on-line mass storage of
operating software and short term storage of data, off-line
long-term storage of data, such as removable disk drive platters,
CD ROMs, or magnetic tape, and a variety of communication ports for
connecting to modems, local or wide area networks, such as the
network 5, and printers for generating reports. Such systems may
also include remote terminals including video displays and
keyboards, touch screens, printers and interfaces to a variety of
clinical devices. The operating systems and specific software
applications will be described in more detail below.
The care management system 30 of FIGS. 1 and 2 includes a file
server 45, such as an IBM or IBM compatible personal computer
having sufficient mass storage 46, such as local hard drives, CD
ROM, magnetic tape, or other media, and appropriate communication
interface capabilities to interconnect with other hardware
comprising the point of care management system. Although many
configurations are possible, in one embodiment the file server
would include hardware such as a data communication router, a large
hard drive to store data for the entire network, and communication
hardware for communicating with the hospital network. Additionally,
a separate computer (CPU) is used to communicate with, control and
provide an interface gateway 27 to the hospital network 5.
A local area network 50, comprising a thin net, or ethernet cabling
is used to connect the central file server 45 to the hardware that
comprises the care management system.
In the present embodiment, the file server 45 of the care
management system is connected by a local area network (LAN) 50 to
computers and other peripheral equipment located in the
institution's pharmacy, at nursing stations located throughout the
institution, and at the patient's bedside. In the embodiment shown,
the module located in the pharmacy comprises a central processing
unit 60 to which is attached a video display 64 and a keyboard 62
for entry and display of patient information and drug parameters.
Also attached to the pharmacy CPU is a bar code reader 68 which is
adapted to read barcode labels that may be attached to drug
containers, equipment, or caregiver identification badges as will
be more fully discussed below. Also connected to the pharmacy CPU
60 is a bar code printer 69 and a printer 66 used for generating
reports containing information about patient history and/or patient
treatment. The printer 66 may also be used to print barcode labels
generated by the pharmacy CPU 60 after patient or drug data is
input by a technician or pharmacist into the pharmacy computer 60
using the keyboard 62 or other means.
Another computer, herein referred to as the nursing CPU 70, is
located at a nursing station. Nursing stations are typically
located in various sections and/or floors of a hospital or clinic
and typically provide a central location for record storage and
monitoring for a number of patient beds. The nursing CPU 70 located
at the nurse station typically includes a video display 74 for
displaying patient or other information pertaining to the operation
of the particular unit of the institution, and a keyboard 72,
mouse, touch screen 73, or other means for entering patient data or
specific commands instructing the nursing CPU 70 to generate
reports relating to either the patient's medical history or the
course and progress of treatment for an individual patient on the
attached printer 76 or on the video display 74. As will be
discussed more fully below, the nursing station CPU 70 may also
generate other reports such as, for example, a printout of drugs
scheduled to be administered to patients, productivity measurements
such as, for example, the amount of time a nurse spends with a
patient or other reports useful for assisting in the efficient
operation of the particular unit or the hospital. For example, a
report listing the actual times of administration versus the
scheduled times for administration may be prepared to assist in
evaluation of staffing requirements.
Each care unit associated with the nursing station typically
comprises one of more patient beds located in private rooms, shared
rooms, or open or semi-open wards that contain multiple beds. In
accordance with an embodiment of the present invention, each
private room, semi-private room, or ward area has at least one
bedside CPU 80 for monitoring and treating one or more patients.
Each bedside CPU 80 has a video display 84 and a keyboard 82,
mouse, touch screen 82, or other device. The bedside CPU 80 can be
used by a nurse, physician or technician to access a variety of
institutional databases to display a variety of information about a
particular patient. This information can include an on-line,
real-time, graphical patient medication administration record (MAR)
that is derived from the patient's medication profile maintained by
the hospital's pharmacy information system 20. The bedside CPU 80
also allows remote access to a patient's records stored by the file
server 45 to display medication history for the patient. This
medication history includes a listing of all drug or other
treatments including past, present and future deliveries to the
patient. Additionally, access to administration records of the
hospital's administration system 40 is available through the
network 5.
Each bedside CPU 80 can be connected through an appropriate
interface to a variety of peripheral equipment. For example, a
barcode reader 90 capable of reading barcodes on a patient's
wristband or medication container; an infusion pump 92 for
delivering medication to the patient in a predetermined, controlled
manner; or various sensors 94 that can automatically monitor a
patient's vital signs and send signals representative of these
vital signs to the computer through an appropriate interface for
storage and later retrieval by a selected software application to
provide a graphic display of the patient's vital signs during the
course of treatment.
A plurality of bedside CPUs are shown in the drawing; however, more
or fewer may exist depending on the particular system and hospital
requirements.
Referring now to FIG. 3, a block diagram illustrating the various
application software modules comprising the care management system
30 is shown. The care management system's 30 application software
is modular in construction to allow installation and operation of
the system with only one or more of the application software groups
present. This provides flexibility in meeting the widely varying
needs of individual institutions where cost and complexity may be
an issue or where the full system is not needed. Each of the
modular applications, however, is fully integratible into the
system.
The programs of the care management system 30 control alarms or
alerts generated by one of the modular applications. Alarms are
routed automatically to the appropriate video display. For example,
an occlusion alarm generated by a pump 92 may remain local for a
predetermined period. After that period the patient's bedside
computer 80 may then broadcast the alarm by causing the alarm to be
communicated over the LAN 50 to alert other hospital staff of a
potential problem or to cause a particular person responsible for
the care of a patient, such as, for example, a physician or nurse,
to be paged.
Each of the modular applications will now be described in detail.
The operation of each of these modular applications in a clinical
setting will be discussed more fully below. The medical
administration management module 110 integrates medical order
information, infusion pump monitoring, and barcode technology to
support the real-time verification and charting of medications
being administered to a patient. The medical administration
management module 110 creates and maintains an on-line, real-time,
patient-specific medication administration record ("MAR") or
integrated medication administration record ("IMAR") for each
patient. This medication administration module 110 contains all of
the information generated in the institution regarding the care
provided to the patient. The medication administration management
module 110 gathers information from the various nursing and bedside
CPU's 70, 80 (FIG. 1) comprising the peripheral hardware of the
care management system 30 that is distributed throughout the
institution. For example, when a physician attending a patient
diagnoses an illness and determines an appropriate course of
treatment for the patient, the physician may prepare a handwritten
medical order specifying the desired therapeutic treatment as well
as any appropriate parameters such as dosage and/or period of
administration. The written prescription is sent through the
institutional mail system to the pharmacy where it is then entered
into the pharmacy information system 20 through a dedicated
terminal, or other means, and is then entered into the care
management system 30.
In another embodiment, the physician accesses the pharmacy
management system 20 through a dedicated terminal or through the
care management system 30 via the network 5 using either a nursing
CPU 70 or a bedside CPU 80. Alternatively, the treatment order may
be entered by a nurse or other qualified caregiver into either the
pharmacy management system 20 or the care management system 30.
Referring now to FIGS. 4-6, a variety of implementations of the
barcode identification system of the present invention are shown.
FIG. 4, for example, shows a patient identification bracelet 170 of
the kind typically used in hospitals and other institutional
settings to ensure that each patient is able to be identified even
if the patient is unconscious or otherwise unable to respond to
questioning. A barcode 175 is printed on a label that is attached
to the patient identification bracelet 170 and has encoded within
its sequence of bars the information necessary to identify the
patient. This barcode may be read using a computerized barcode
reader, such as those shown connected to the pharmacy CPU 60 and
the bedside CPUs 80 (FIG. 1). The barcode reader comprises a light
emitting and receiving wand 95 that is scanned across the barcode.
The light emitted by the wand 95 is reflected by the sequence of
dark and light lines comprising the barcode into the receiving lens
of the wand 95. A sensor in the wand 95 converts the received light
into a signal that is then transmitted to the CPU. A software
application program running on the CPU then decodes the signal into
the data represented by the barcode in a manner well known to one
skilled in the art. Using appropriate software programs, this data
may then be automatically entered into a database stored in the
CPU's memory or disk storage.
Barcode systems are extremely flexible and the amount of
information that can be represented by the barcode, while limited,
can be used in a variety of ways. For example, as depicted in FIG.
5, a drug container 185 is identified by a label 180 having a
barcode 182 printed thereon. This barcode 182 can represent the
patient identification and the medical order number, and any other
information the institution finds helpful in dispensing the drug
and tracking the treatment. The barcode 182 may also be read using
a barcode reader, and, using suitable application software such as
that included within the medical administration management module
110, discussed below, can be used to link the drug container and
its contents with the patient identification bracelet 170 affixed
to a patient to ensure the right drug is delivered to the right
patient at the right time in the right manner. The use of barcodes
is not limited to the implementations discussed above. A sheet 190
of barcode labels 177 having barcodes 175 is shown in FIG. 6. Such
labels can be printed by a printer connected to the pharmacy CPU 60
of the care management system 30 or, alternatively, by any other
printer connected to any other hospital information system that can
be programmed to produce barcodes bearing the information in a form
that can be read by the barcode readers connected to the various
CPUs of the care management system 30. These barcode labels 177 may
then be affixed to clinical devices, patient belongings, or other
items where positive identification is needed.
One of the key advantages of the medical administration management
module 110 (FIG. 3) is that the module works in concert with the
barcode labels described above. When the medication administration
management module 110 is implemented using the hardware system
described above comprising a pharmacy CPU 60, barcode reader 68,
and printer 66, together with a bedside CPU 80 with a connected
barcode reader 90, the care management system 30 ensures that
medication is administered to the right patient, in the right dose,
along the right route and at the right time.
When the medication to be administered is of the type that is
typically delivered to the patient using an infusion pump, the
medical administration management module 110 automatically records
the start time of the infusion, queries the pump periodically
throughout the infusion and maintains a continuous log of the
infusion, and records the end time of the infusion and the volume
infused in a patient's MAR. If the infusion pump connected to the
bedside CPU has a programmable display, the name of the drug, as
well as other important information concerning the progress of the
infusion can be displayed on the infusion pump throughout the
infusion to provide a visual display of the status for the
infusion. One such pump is shown in FIG. 7. The particular infusion
pump depicted in FIG. 8 has three pumping channels. Two of the
channels are displaying the name of the drug being infused.
Because the medication administration management module 110
maintains an on-line, real-time, patient specific graphical
medication administration record that includes both past, present
and future scheduled medications, a nurse may select a scheduled
dosage on the MAR and indicate that it will not be administered for
specified reasons selected from a list of options that are
dependant upon the health status of the patient at a particular
time. This system also allows a nurse to select a scheduled dose on
the MAR, and record notes and observations about the dose selected
from a list of options. The medical administration management
module 110 also provides on-line, real-time help screens that can
be accessed by a nurse or other caregiver to display specific
information about selected medication and dose to be dispensed.
The medication administration management module 110 provides a list
of on-going infusions that can be displayed on the video display of
the pharmacy CPU 60 such as is shown in FIG. 8. Drug
administrations that will terminate within a preselected time
period may be distinguished from other administrations by color
highlighting or other means. The time remaining, drug, and patient
name are presented as well as buttons for program control.
The medication administration module 110 records and maintains in a
stored file a log of alerts that are generated when any discrepancy
is identified, for example, during the verification process which
will be discussed more fully below. The medication administration
module 110 also allows the nurse to acknowledge and correct the
discrepancy in real-time, or override the alert by entering the
appropriate command. Even where the nurse is allowed to override
the alert, the medication administration application module 110
prompts the nurse for a reason for each alert override and then
automatically enters the reason into the MAR for the patient.
The medication administration management module 110 assists the
nurse or other health care professional in efficiently delivering
care to the patients by providing the ability to perform on-line
queries of the patient's MARs and produce reports designed to
assist the nurse in planning medication administration and in
scheduling the workload of dispensing the medication to the many
patients for which a nursing unit is typically responsible. For
example, the video display may be color coded to indicate the
status and schedule of each drug administration, such as the
patient's IMAR shown in FIG. 9. A drug delivery window extending
from thirty minutes prior and thirty minutes after the scheduled
administration time may be indicated by a yellow band on the
display. Other reports such as the FIG. 10 task list may, for
example, include scheduling of drug administrations to ensure
proper medication of the patient while distributing the workload
over a period of time to ensure that all medication is given
promptly. The system may also display either visuals alerts on the
nurse station video display 74 or produce a printed report on the
printer 76 to provide a permanent record of any medication
administration that is running late or has been rescheduled. The
medication administration module 110 may be programmed to operate
in an automatic fashion, automatically providing standard reports
at the nursing station at predetermined intervals, such as, for
example, every 30 minutes, as determined by the needs of the
particular nursing unit and institution.
The clinical monitoring and event history module 130 shown in FIG.
3 is designed to monitor a variety of clinical devices attached to
the network in a real-time manner and provides information about
those devices to monitoring stations located elsewhere on the
network. For example, the clinical monitoring and event history
module 130 can be configured to monitor a plurality of clinical
devices that are in use to deliver medication to patients in the
private rooms, semi-private rooms or ward areas in a nursing unit.
The clinical monitoring and event history module 130 retrieves
real-time data from each device, and displays a visual
representation of each device including all significant data
related to its status and settings on the video display 74
connected to the Nursing CPU 70 (FIGS. 1 and 2). For example, in
the case where the clinical monitoring and event history module 130
is monitoring an infusion pump 92, a nurse at the nursing station
can access the status for that pump wherein the display 74 attached
to the nurse CPU 70 then displays information regarding the status
of the infusion being performed at that time. For example,
information can include the name of the drug being infused, the
patient's name, the scheduled start, the actual start of infusion,
the scheduled end of infusion, the projected end of infusion, the
amount of drug infused, the amount of drug remaining to be infused
and any alert or discrepancy conditions that may need attention by
the nurse. Because the care management system 30 is a fully
integrated system, the medical administration management module 110
works in concert with the clinical monitoring and event history
module 130 so that a nurse, doctor or technician may, after
evaluating the status of the infusion displayed on either the video
display 74 at the nursing CPU 70 or on the video display 84 at the
bedside CPU 80 may, by using the touch screen 73, 83 of the
computer, adjust the infusion regimen accordingly using, for
example, a screen displayed on the video display 74, 84 as shown in
FIG. 11.
The clinical monitoring event history module 130 may also be
programmed to immediately display alarm conditions on remote
monitoring screens, such as the video display 74 attached to the
nursing CPU 70, as the alarm occurs. For example, the status of
each patient's infusion can be represented on a video display at
the nursing station as shown by the OVERVIEW computer screen in
FIG. 12. When an alert occurs, the box representing the patient'
room flashes red to attract attention to the alert. Displaying the
alarm condition in this manner allows a nurse to quickly and easily
identify the patient from the nursing station and take appropriate
action to address the condition causing the alarm. The system may
also be programmed to display certain alarms that have been
identified as particularly important events at other video displays
located throughout the institution, such as the video display 64
attached to the pharmacy CPU 60 located in the institution's
pharmacy. The manner of overview display in FIG. 12 also
facilitates record update. For example, when patients move rooms,
clicking on the patient's name, dragging that patient to the new
room, and unclicking will cause the records to reflect the
patient's move and the display will now show the patient in that
room.
The clinical device tracking and reporting module 120 shown in FIG.
3 is used to maintain a record of the location of each clinical
device and the history of its use in the institution. This system
maintains a record of the current or last known location within the
institution of each clinical device used in the institution, such
as an infusion pump or vital sign sensor. Thus, the appropriate
equipment can be easily located by a nurse or a technician for a
given therapy regimen or vital sign measurement. This is
particularly useful in a large hospital or clinic having many
patient rooms, patient beds, or treatment areas where equipment may
be temporarily misplaced. This system is also useful in those
particular instances where an emergency occurs where treatment
requires a particular piece of equipment. The status of that
equipment can be easily ascertained from a remote video terminal,
such as the video display 74 connected to the nursing CPU 70.
The clinical device tracking and reporting module 120 also
maintains a record containing the usage history of each clinical
device, including information about the patient it was used to
treat, its location, the date, time, duration of use, any alarms
that occurred and what medications were dispensed. This history may
also contain the maintenance and calibration records for a clinical
device. Such information can be queried on-line by technicians,
nurses or other hospital administration personnel to generate
reports to assist in locating the clinical device, report on the
historical usage of the device, and to provide a log of
preventative maintenance and equipment calibration. The efficient
calibration of complex and sensitive clinical devices is
particularly important in a heath care institution to maintain
accuracy and quality of therapeutic treatment delivery. Maintaining
a history of the usage of the device is also helpful to justify
purchasing additional clinical devices when needed, or where the
record indicates that a particular clinical device has become
obsolete and needs to be replaced by a newer model of the
device.
The care management system 30 also includes a consumable tracking
module 140 that maintains a record of all consumable item usage for
treatment of each patient. This record ensures that appropriate
supplies are ordered and delivered to the nursing unit in a timely
and cost-efficient manner to prevent outages of necessary supplies.
Such information may also be used by the hospital inventory systems
through an appropriate interface or other management system to
ensure that the supply purchasing is done as cost-effectively as
possible. The consumable tracking module 140 provides on-line
queries and report generation summarizing consumable uses for a
particular patient, a particular nursing unit, or a variety of
other purposes.
The unit management tool module 150 assists nurses in sharing
information related to patients and automates routine transactions
within the nursing unit. The unit management tool module 150 allows
a nurse to record the allergies, handicaps, and special care needs
of the patient which, cooperating with the medication
administration record module 110 and the clinical monitoring and
event history module 130, displays that information prominently on
all appropriate display screens, either at the pharmacy video
display 64, the nursing video display 74 or at the bedside video
display 84 (FIG. 1). The unit management tools module 150 also
allows a nurse to record patient transfers and the times when the
patient is out of the room or off the floor, such as, for example,
when the patient is transferred to surgery or to a different part
of the institution for a particular kind of treatment such as
rehabilitative therapy. This system may also be programmed to
signal an alarm when a patient has been disconnected from the
system longer than scheduled, for example, when the patient
disconnects from the infusion to attend to personal hygiene. This
function ensures that an alarm or alert is sounded and that
appropriate personnel are notified of any potential problems and
can take the necessary actions to alleviate the alert
condition.
The knowledge resource tools module 160 provides a framework for
information sharing among the various units in the hospital and
also supports an assortment of everyday tools to used by the
nurses, physicians and technicians involved in the delivery of
health care within the institution. This module allows or assists
in integrating external information sources into the care system 30
to improve the effectiveness of the care management team in
treating the patients in the institution.
For example, the knowledge resource tools module 160 provides a
variety of on-line tools including, for example, a calculator, a
dose rate calculator for calculating the appropriate dosage and
infusion rate for a particular drug to be infused into a patient, a
standard measurement conversion calculator for converting between
units of measurement, a skin surface area calculator, and a timer
and stopwatch. These resources may be displayed on the video
displays 64, 74, 84 at appropriate points within the system, and
are available from any CPU either in the pharmacy, at the nursing
station or at the bedside. These application tools can be
programmed to appear on the video display 64, 74, 84 either
automatically, such as, for example, when an infusion pump is
configured at the start of an infusion to assist in the calculation
of a dose rate. These resources may also be available upon entry of
the appropriate command by a nurse, physician or technician.
Referring once again to FIG. 2, a device management subsystem 192
is shown and comprises a microcomputer. The subsystem monitors the
status of the clinical devices, such as the pumps. Alternately, the
subsystem 192 may be included in another microcomputer, such as a
bedside CPU 80.
The background monitoring system 195 may also be disposed in a
stand-alone microcomputer or may be incorporated in an existing
microcomputer. The subsystem performs background tasks such as
monitoring the status of the interface gateway 27.
As depicted in FIG. 2, the care management system 30 is connected
to other systems in the institution via an interface 10. This
interface may support standard health level 7 (HL7) interfaces to
the hospital's other information systems and can also support
custom interfaces to systems or devices that do not support the HL7
standard. The system interfaces may be either real-time or batch
mode, although a real-time interface to a hospital's pharmacy
system is required to support the on-line medical administration
records keeping function of the medical administration management
module 110.
The care management system software can be written to operate on a
variety of operating systems to suit the needs of a variety of
institutions. In a present embodiment, the software is written to
interface with the nurses and physicians using the Windows
environment (Windows is a trademark of Microsoft, Inc.) on IBM
compatible micro-computers. The Windows environment is well-known
by those skilled in the art and will not be described in detail
herein. The care management system software, when implemented using
the Windows system, is particularly useful in that the Windows
operating system provides the ability to load several programs at
once. Multitasking programs, allowing several application programs
to run simultaneously yet providing immediate access to the various
software modules of the care management system 30 may also be
used.
One particular mode of operation of the care management system will
now be described. As described above, a patient entering a hospital
or other care-giving institution is provided with a wristband,
necklace, ankle band or other identifier that is affixed to the
patient in a manner so that the patient can be identified even if
the patient is unconscious or otherwise unresponsive. Such a
wristband 170 is depicted in FIG. 4. In one embodiment, the
wristband 170 barcode represents the name of the patient and other
information that the institute has determined is important and also
includes a barcode 175. The information printed upon the band, such
as name, age, allergies or other vital information is encoded into
the barcode 175.
After the patient is admitted and situated in a bed within the
institution, the patient is typically evaluated by a physician and
a course of treatment is prescribed. The physician prescribes the
course of treatment by preparing an order, which may request a
series of laboratory tests or administration of a particular
medication to the patient. The physician typically prepares the
order by filling in a form or writing the order on a slip of paper
to be entered into the hospital's system for providing care.
If the order is for administration of a particular medication
regimen, the order will be transmitted to the institution's
pharmacy. The order will arrive in written form at the pharmacy,
will be evaluated by the pharmacy and processed. The pharmacy then
prepares the medication according to the requirements of the
physician. The pharmacy packages the medication in a container,
such as the container 185 shown in FIG. 5. Normally, a copy of the
order, or at a minimum, the patient's name, the drug name, and the
appropriate treatment parameters are represented on a label that is
then affixed to the drug container 185. According to one embodiment
of the present invention, this information is represented by a
barcode 182, that is then printed on a label 180. This barcode
label 182 may be automatically generated using a printer capable of
printing barcodes, such as, for example, a printer 69 attached to
the hospital's pharmacy information system 20. The existence of
this medication order is made available by the hospital's pharmacy
information system 20 and is stored by the file server 45.
Generally, the medication is then delivered to the appropriate
caregiving unit for administering to the patient. A nurse or
technician carries the drug container 185 to the appropriate
patient. In accordance with one embodiment of the present
invention, the nurse or technician first read the barcode 175 on
the patient ID bracelet 170 using the barcode reader 90 connected
to the bedside CPU 80. The nurse or technician would then read the
barcode 182 on the label 180 affixed to the drug container by
swiping the barcode reader 95 across the barcode 182 printed on the
label 180 of the drug container 185. Additionally, a record of the
identity of the caregiver dispensing the medication may be obtained
by reading the barcode 205 (FIG. 5A) printed on an identity badge
200 typically worn by all institution personnel.
For certain drugs, the care-giver is prompted to enter data
descriptive of a selected patient parameter or parameters, such a
laboratory value or a current vital sign, before completing the
verification process. For example, the care-giver may be prompted
to measure and enter a value for a patient's blood pressure before
administering certain selected drugs. The system may include ranges
of acceptable values for the parameters. If the system detects an
out-of-range value for the parameter, the system causes an alarm to
be provided. In an alternative embodiment, the parameters could be
monitored and entered into the system automatically, eliminating
the need for manual entry by the care-giver.
The data obtained then is analyzed by the medication administration
management module 110 which records the therapeutic regimen
information in the patient's MAR, and verifies that the right
medication is being given to the right patient in the right dose by
the right route and at the right time. If the medication
administration management module 110 detects a discrepancy between
the barcoded information printed on the patient bracelet 170 and
the barcoded information on the label 180 affixed to the medication
container 185, an alert is sounded and the appropriate information
is displayed on the video display 84 attached to the bedside CPU
80. The nurse or technician then either corrects the discrepancy by
either re-reading the barcode 175 on the patient's bracelet 170 and
the barcode 182 on the medication container 185 or, alternatively,
by entering the appropriate information into the bedside CPU 80
using the keyboard 82 or touch screen 83, mouse, or other device.
In the event that the nurse or technician determines that the
discrepancy cannot be automatically corrected by re-reading the
barcodes and that the discrepancy is minor and will not affect the
accuracy or safety of the delivery of the medication, the nurse or
technician may override the alert.
In an embodiment of the present invention, where the medication is
to be delivered using an infusion pump, such as the infusion pumps
92, 94 attached to the bedside CPU 80, the care management system
automatically downloads information consisting of the appropriate
configuration parameters for the infusion from the pharmacy CPU 60
through the local area network 50 into the bedside CPU 80 and then
into the infusion pump 92 when the verification function of the
medical administration management module 110 is complete. This is
particularly advantageous in that one potential source of
inaccuracy is eliminated by automatically configuring the pump,
thus eliminating the need for the nurse or technician to manually
enter the parameters necessary to configure the infusion pump 92.
In one embodiment, the infusion pumps 92 comprise IVAC Corporation
Model 570 volumetric pumps. In an embodiment where the pumps cannot
be automatically configured by downloading parameters from the
network, the care management system 30 only verifies that the right
treatment is being administered to the right patient. The pump must
then be manually configured by the physician, nurse or
technician.
Once the infusion pump is configured, the technician then starts
the infusion by pressing the appropriate control on the infusion
pump. Starting pump that is capable of being monitored
automatically by the care management system 30 causes a signal to
be transmitted from the pump to the bedside CPU 80 which is then
logged by the clinical monitoring and event history module 130 and
entered by the medical administration management module 110 into
the patient's MAR. In the case where the institution is using a
pump that is not capable of being configured by downloading
parameters from the network, the nurse or other caregiver logs the
start of the infusion using the touch screen device, mouse or other
device connected to the bedside CPU 80. In this case, the video
displays of the care management system 30 that display information
about the status of the infusion will not display real-time data.
Rather, the care management system 30 will project what the status
of the infusion should be given the infusion parameters, the time
elapsed since the infusion began, and any other events that were
manually logged by the caregiver that may have affected the
progress of the infusion.
The care management system 30, utilizing the application modules
described above, monitors the infusion process in a real-time
manner, providing alerts on the appropriate video display screens
located throughout the institution and allows intervention by
nurses or other caregivers at remote locations if necessary. If the
pharmacy management system 20 is directly linked to the care
management system 30, the care management system 30 may also
provide a scheduling report to the pharmacy in determining the
status of ongoing infusions, as well as in scheduling the preparing
of medications for future infusions.
In another embodiment, the present invention includes a "Code Mode"
that allows a care-giver to bypass the system to immediately cause
a list of drugs that have been preselected by the institution to be
used in an emergency situation. The initiation of the "Code Mode"
causes a time-stamp to be placed in the patient's MAR along with
the identity of the drug selected from the displayed list of drugs
to be used to treat the emergency. This feature ensures that the
emergency, and the treatment used to address the emergency, are
accurately recorded in the patient's MAR.
While one particular embodiment of the present invention has been
described above, alternative configurations of the care management
system network are possible. For example, one alternative
embodiment of the care management system 30 is depicted in FIG. 13.
In this configuration, clinical devices 210 are connected by means
of appropriate interfaces and cabling 215 to a bedside data
concentrator 220 which would typically be located outside of a
private room, semi-private room or ward area. In this
configuration, there is no bedside CPU 80 as described previously.
Instead, the bedside data concentrator 220 is connected through an
appropriate interface and cabling to the local area network 50,
where the data gathered from the clinical devices is then available
for processing by the care management system and display at the
various monitoring stations, such as either in the pharmacy or at
the nurse station 70. In this embodiment, there is no bedside CPU
80 having a keyboard 82 for data entry or a video display 84 for
display of either clinical device information or patient
information.
A further embodiment of the point of care management system 30
local area network is depicted in FIG. 14. In this embodiment, the
file server and monitoring stations are connected using appropriate
interfaces and ethernet cabling to an RF data concentrator 225. At
the bedside locations in the private rooms, semi-private rooms or
ward areas of the institution, the clinical devices 210 and barcode
reader 90 at the bedside are connected to an RF
transmitter/receiver 230. This RF transmitter transmits the
information gathered from the clinical devices and the barcode
reader to the RF data concentrator 225 attached to the local area
network 50. Thus, expensive cabling is not required to connect
every patient treatment area. Additionally, flexibility in locating
the clinical devices 210 and barcode reader 90 is obtained as well
as allowing the ability to reconfigure the patient treatment area
without costly rewiring of the ethernet cabling.
Yet another embodiment of the care management system 30 local area
network 50 configuration is shown in FIG. 15. In this
configuration, the ethernet cabling connecting the pharmacy CPU,
the nurse station nursing CPU 70 and bedside CPUs and clinical
devices is eliminated entirely. Each hardware element, comprising
the file server 45, nursing CPU 70, pharmacy CPU 60 and bedside
CPUs 80 and clinical devices 210 and/or barcode readers 90 is
connected to an RF transmitter/receiver 230. In this manner, all of
the information is transmitted throughout the local area network by
way of radio transmission rather than by using costly network
cabling. Such a system would additionally allow for the use of
portable computers 240 having RF transmitter/receivers 230 that
could then be carried with physicians, nurses or technicians as
they circulate through the institution. With this configuration,
caregiving personnel could access the care management system either
spontaneously or upon notification of an alert no matter where they
were in the institution at any given time. Such a system would be
particularly useful in a large institution where caregiving
personnel are likely to be responsible for many hospital beds or
when personnel are out of the area or off the floor.
While several forms of the invention have been illustrated and
described, it will also be apparent that various modifications can
be made without departing from the spirit and scope of the
invention. Accordingly, it is not intended that the application be
limited, except by the appended claims.
* * * * *